MEDICARE: AMBER ALEAN SHAW LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	68694	TX
2	104100000X	Social Worker	68694	TX

General Provider Information

NPI Number	:	1407562416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER ALEAN SHAW LCSW

Provider Business Mailing Address
First Line	:	6850 AUSTIN CENTER BLVD STE 210
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-3131
Country	:	US
Telephone Number	:	512-378-4222
Fax Number	:

Provider Business Practice Location Address
First Line	:	6850 AUSTIN CENTER BLVD STE 210
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-3131
Country	:	US
Telephone Number	:	512-378-4222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2023
Last Update Date	:	08/02/2023

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